Static outliers for King Street Surgery

There is substantial variation in prescribing behaviours, across various different areas of medicine. Some variation can be explained by demographic changes, or local policies or guidelines, but much of the remaining variation is less easy to explain. At OpenPrescribing we are piloting a number of data-driven approaches to identify unusual prescribing and collect feedback on this prescribing to inform development of new tools to support prescribers and organisations to audit and review prescribing.

This report has been developed to automatically identify prescribing patterns at a chemical level which are furthest away from “typical prescribing” and can be classified as an “outlier”. We calculate the number of prescriptions for each chemical in the BNF coding system using the BNF subparagraph as a denominator, for prescriptions dispensed between April 2021 and August 2021. We then calculate the mean and standard deviation for each numerator and denominator pair across all practices/CCGs/PCNs/STPs. From this we can calculate the “z-score”, which is a measure of how many standard deviations a given practice/CCG/PCN/STP is from the population mean. We then rank your “z-scores” to find the top 5 results where prescribing is an outlier for prescribing higher than its peers and those where it is an outlier for prescribing lower than its peers.

It is important to remember that this information was generated automatically and it is therefore likely that some of the behaviour is warranted. This report seeks only to collect information about where this variation may be warranted and where it might not. Our full analytical method code is openly available on GitHub here.

The DataLab is keen to hear your feedback on the results. You can do this by completing the following survey or emailing us at ebmdatalab@phc.ox.ac.uk. Please DO NOT INCLUDE IDENTIFIABLE PATIENT information in your feedback. All feedback is helpful, you can send short or detailed feedback.

Prescribing where King Street Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Paliperidone☰	26	Antipsychotic drugs	1566	0.02	0.00	0.00	8.98
Paliperidone 9mg modified-release tablets : 26
Acetylcysteine☰	166	Mucolytics	273	0.61	0.02	0.08	7.70
NACSYS 600mg effervescent tablets : 165 Acetylcysteine 600mg effervescent tablets sugar free : 1
Ciclosporin (Eye Anti Inflammatory)☰	105	Other anti-inflammatory preparations	203	0.52	0.05	0.07	6.91
Ikervis 0.1% eye drops 0.3ml unit dose : 89 Ciclosporin 0.1% eye drops 0.3ml unit dose : 16
Dutasteride☰	151	Male sex hormones and antagonists	405	0.37	0.06	0.07	4.34
Dutasteride 500microgram capsules : 151
Liquid paraffin☰	5	Emollient bath and shower preparations	18	0.28	0.03	0.07	3.42
Doublebase emollient bath additive : 5

Prescribing where King Street Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Carbocisteine☰	97	Mucolytics	273	0.36	0.97	0.08	-7.66
Carbocisteine 375mg capsules : 82 Carbocisteine 750mg/5ml oral solution sugar free : 1 Carbocisteine 750mg/10ml soln 10ml sachets sugar free : 9 Carbocisteine 250mg/5ml oral solution : 5
Finasteride☰	184	Male sex hormones and antagonists	405	0.45	0.82	0.12	-3.16
Finasteride 5mg tablets : 184
Sodium cromoglicate☰	37	Other anti-inflammatory preparations	203	0.18	0.67	0.18	-2.66
Sodium cromoglicate 2% eye drops : 30 Sodium cromoglicate 2% eye dps 0.3ml ud preservative free : 1 Optrex Allergy 2% eye drops : 1 Sodium cromoglicate 2% eye drops preservative free : 5
Urea hydrogen peroxide☰	0	Removal of ear wax and other substances	1	0.00	0.83	0.34	-2.47
Rivaroxaban☰	72	Oral anticoagulants	2533	0.03	0.24	0.12	-1.77
Rivaroxaban 20mg tablets : 59 Rivaroxaban 10mg tablets : 2 Rivaroxaban 2.5mg tablets : 2 Rivaroxaban 15mg tablets : 9